Surgical forceps

ABSTRACT

A forceps includes an end effector assembly including first and second jaw members. One or both of the jaw members is movable relative to the other between a spaced-apart position and an approximated position for grasping tissue therebetween. One or both of the jaw members is configured to conduct energy between the jaw members and through tissue grasped therebetween to treat tissue. An insulative tubular member is movable relative to the end effector assembly between a retracted position, wherein the insulative tubular member is positioned proximally of the end effector assembly, and an extended position, wherein the insulative tubular member is disposed about the end effector assembly. A monopolar member is configured to apply energy to tissue to treat tissue when the insulative tubular member is disposed in the extended position.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 15/082,189, filed on Mar. 28, 2016, which is acontinuation application of U.S. patent application Ser. No. 14/721,394,filed on May 26, 2015, now U.S. Pat. No. 9,358,028, which is acontinuation application of U.S. patent application Ser. No. 13/537,577,filed on Jun. 29, 2012, now U.S. Pat. No. 9,039,691, the entire contentsof each of which is hereby incorporated herein by reference.

BACKGROUND

Technical Field

The present disclosure relates to surgical instruments and, moreparticularly, to a bipolar surgical forceps including an extendablemonopolar element.

Background of Related Art

Bipolar electrosurgical forceps typically include two generally opposingelectrodes charged to different electric potentials to selectively applyenergy to tissue. Bipolar electrosurgical forceps utilize bothmechanical clamping action and electrical energy to effect hemostasis byheating tissue and blood vessels to coagulate and/or cauterize tissue.Certain surgical procedures require more than simply cauterizing tissueand rely on the unique combination of clamping pressure, preciseelectrosurgical energy control and gap distance (i.e., distance betweenopposing jaw members when closed about tissue) to “seal” tissue, vesselsand certain vascular bundles. Typically, once a vessel is sealed, thesurgeon has to accurately sever the vessel along the newly formed tissueseal. Accordingly, many forceps have been designed which incorporate aknife or blade member that effectively severs the tissue after forming atissue seal.

Monopolar surgical instruments, on the other hand, include an activeelectrode, and are used in conjunction with a remote return electrode,e.g., a return pad, to apply energy to tissue. Monopolar instrumentshave the ability to rapidly move through tissue and dissect throughnarrow tissue planes.

In some surgical procedures, it may be beneficial to use both bipolarand monopolar instrumentation, e.g., procedures where it is necessary todissect through one or more layers of tissue in order to reachunderlying tissue(s) to be sealed. Further, it may be beneficial,particularly with respect to endoscopic surgical procedures, to providea singe instrument incorporating both bipolar and monopolar features,thereby obviating the need to alternatingly remove and insert thebipolar and monopolar instruments in favor of one another.

SUMMARY

As used herein, the term “distal” refers to the portion that is beingdescribed which is further from a user, while the term “proximal” refersto the portion that is being described which is closer to a user.Further, to the extent consistent, any of the aspects described hereinmay be used in conjunction with any of the other aspects describedherein.

In accordance with aspects of the present disclosure, a forceps isprovided including an end effector assembly having first and second jawmembers. One or both of the jaw members is movable relative to the otherbetween a spaced-apart position and an approximated position forgrasping tissue therebetween. One or both of the jaw members isconfigured to conduct energy between the jaw members and through tissuegrasped therebetween to treat tissue. The forceps also includes aninsulative tubular member movable relative to the end effector assemblybetween a retracted position, wherein the insulative tubular member ispositioned proximally of the end effector assembly, and an extendedposition, wherein the insulative tubular member is disposed about theend effector assembly. The forceps further includes a monopolar memberconfigured to apply energy to tissue to treat tissue when the insulativetubular member is disposed in the extended position.

In one aspect, the monopolar member includes an inner tubular memberdisposed within and engaged to the insulative tubular member. A portionof the inner tubular member extends distally from the insulative tubularmember such that, in the extended position of the insulative tubularmember, the portion of the inner tubular member extends distally fromthe end effector assembly for applying energy to tissue to treat tissue.

In another aspect, the portion of the inner tubular member that extendsdistally from the insulative tubular member is further configured tofacilitate mechanical dissection of tissue.

In another aspect, the portion of the inner tubular member that extendsdistally from the insulative tubular member includes one of a beveleddistal end, an annular distal end, a blade extending distally therefrom,and a hook extending distally thereform.

In still another aspect, the inner tubular member includes a releasablyengagable distal tip. The releasably engagable distal tip extendsdistally from the insulative tubular member. Further, the releasablyengagable distal tip may be selected from a plurality of distal tipsincluding one or more of a first distal tip including a beveled distalend, a second distal tip including a blade extending distally therefrom,a third distal tip including a hook extending distally thereform, and afourth distal tip including an annular distal end.

In yet another aspect, the forceps further includes a shaft coupled tothe end effector assembly at a distal end of the shaft. In such aspects,the insulative tubular member may be disposed about the shaft and may beslidable relative to the shaft between the retracted and extendedpositions.

In still yet another aspect, the forceps further includes a slideassembly including a slide knob. The slide knob is coupled to theinsulative tubular member and selectively movable between a firstposition and a second position for moving the insulative tubular memberbetween the retracted and extended positions.

In another aspect, the forceps further includes a first activationswitch for selectively supplying energy to the jaw member(s) and asecond activation switch for selectively supplying energy to themonopolar member. Further, the first activation switch and/or the secondactivation switch may be inhibited from being activated when theinsulative tubular member is disposed in the extended and retractedpositions, respectively.

In yet another aspect, one or both of the jaw members includes a distaltip portion. The distal tip portion of the jaw member(s) defines themonopolar member for applying energy to tissue to treat tissue when theinsulative tubular member is disposed in the extended position. Thedistal tip portion of the jaw member(s) may further be configured tofacilitate mechanical dissection of tissue. Additionally, the insulativetubular member may define a cut-out. In such a configuration, the distaltip portion of the jaw member(s) may be configured to extend through thecut-out when the insulative tubular member is disposed in the extendedposition.

Another forceps provided in accordance with aspects of the presentdisclosure includes an end effector assembly including first and secondjaw members. One or both of the jaw members is movable relative to theother between a spaced-apart position and an approximated position forgrasping tissue therebetween. One or both of the jaw members isconfigured to conduct energy between the jaw members and through tissuegrasped therebetween to treat tissue. The forceps further includes amonopolar assembly. The monopolar assembly includes an insulativetubular member and an electrically-conductive distal member configuredto apply energy to tissue to treat tissue. The electrically-conductivedistal member is engaged to and extends distally from the insulativetubular member. The monopolar assembly is movable relative to the endeffector assembly between a retracted position, wherein the monopolarassembly is positioned proximally of the end effector assembly, and anextended position, wherein the insulative tubular member substantiallysurrounds the end effector assembly and the electrically-conductivedistal member extends distally from the end effector assembly.

In one aspect, the electrically-conductive distal member includes areleasably engagable distal tip, the releasably engagable distal tipextending distally from the insulative tubular member. The releasablyengagable distal tip may be selected from a plurality of distal tipsincluding a first distal tip including a beveled distal end, a seconddistal tip including a blade extending distally therefrom, a thirddistal tip including a hook extending distally thereform, and a fourthdistal tip including an annular distal end.

In another aspect, the forceps further includes a slide assembly havinga slide knob. The slide knob is coupled to the monopolar assembly and isselectively movable between a first position and a second position formoving the monopolar assembly between the retracted and extendedpositions.

A method of treating tissue is also provided in accordance with aspectsof the present disclosure. The method includes grasping tissue betweenfirst and second jaw members, applying energy between the first andsecond jaw members and to tissue grasped therebetween to treat tissue,advancing a monopolar assembly including an insulative tubular memberand an electrically-conductive distal member about the first and secondjaw members such that the insulative tubular member substantiallysurrounds the first and second jaw members and theelectrically-conductive distal member extends distally from the firstand second jaw members, and applying energy from theelectrically-conductive distal member to tissue to treat tissue.

In one aspect, the step of applying energy between the jaw membersfurther includes sealing tissue grasped between the jaw members and thestep of applying energy from the electrically-conductive distal memberfurther includes electrically dissecting tissue.

In another aspect, the electrically-conductive distal member includes areleasably engagable distal tip. In such aspects, the method furtherincludes selecting the distal tip from a plurality of distal tipsincluding a first distal tip including a beveled distal end, a seconddistal tip including a blade extending distally therefrom, a thirddistal tip including a hook extending distally thereform, and a fourthdistal tip including an annular distal end, and engaging the selecteddistal tip to the electrically-conductive distal member.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects of the present disclosure are described herein withreference to the drawings wherein like reference numerals identifysimilar or identical elements:

FIG. 1 is a front, perspective view of an endoscopic surgical forcepsconfigured for use in accordance with the present disclosure;

FIG. 2 is an enlarged, perspective view of an end effector assembly ofthe forceps of FIG. 1;

FIG. 3 is a longitudinal, cross-sectional view of the forceps of FIG. 1;

FIG. 4A is a longitudinal, cross-sectional view of the end effectorassembly of FIG. 2 with jaw members of the end effector assemblydisposed in a spaced-apart position;

FIG. 4B is a longitudinal, cross-sectional view of the end effectorassembly of FIG. 2 with the jaw members disposed in an approximatedposition;

FIG. 4C is a longitudinal, cross-sectional view of the end effectorassembly of FIG. 2 with the jaw members disposed in the approximatedposition and a knife assembly disposed in a deployed position;

FIG. 4D is a longitudinal, cross-sectional view of the end effectorassembly of FIG. 2 with a monopolar assembly disposed in an extendedposition;

FIG. 5 is a longitudinal, cross-sectional view of a distal end of themonopolar assembly of FIG. 4D;

FIGS. 5A-5D are longitudinal, cross-sectional views of various distaltips releasably engagable with the monopolar assembly of FIG. 4D;

FIG. 6A is a side, perspective view of another end effector assemblyconfigured for use with the forceps of FIG. 1 including a monopolarassembly disposed in a retracted position;

FIG. 6B is a side, perspective view of the end effector assembly of FIG.6A with the monopolar assembly disposed in an extended position;

FIG. 6C is side, perspective view of another end effector assemblyconfigured for use with the forceps of FIG. 1 including a monopolarassembly disposed in an extended position;

FIG. 6D is side, perspective view of another end effector assemblyconfigured for use with the forceps of FIG. 1 and shown with partsseparated, the end effector assembly including a monopolar assemblydisposed in a retracted position;

FIG. 6E is a top, perspective view of another end effector assemblyconfigured for use with the forceps of FIG. 1 shown including amonopolar assembly disposed in an extended position;

FIG. 6F is a bottom, perspective view of the end effector assembly ofFIG. 6E shown including the monopolar assembly disposed in a retractedposition;

FIG. 7A is a top view of a jaw member of another end effector assemblyconfigured for use with the forceps of FIG. 1 with a monopolar assemblydisposed in an extended position;

FIG. 7B is an end view of the jaw member of FIG. 7A with the monopolarassembly disposed in a retracted position;

FIG. 8A is a longitudinal, cross-sectional view of another end effectorassembly configured for use with the forceps of FIG. 1 with a monopolarassembly disposed in a retracted position;

FIG. 8B is a longitudinal, cross-sectional view of the end effectorassembly of FIG. 8A with the monopolar assembly disposed in an extendedposition;

FIG. 9A is a side view of another end effector assembly configured foruse with the forceps of FIG. 1 with jaw members disposed in aspaced-apart position;

FIG. 9B is a side view of the end effector assembly of FIG. 9A with thejaw members disposed in an approximated position;

FIG. 9C is a side view of the end effector assembly of FIG. 9A with thejaw members disposed in the approximated position and including aninsulative sleeve disposed thereabout; and

FIG. 10 is a side view of another end effector assembly configured foruse with the forceps of FIG. 1.

DETAILED DESCRIPTION

Referring now to FIGS. 1-3, a forceps including features for operatingin both a bipolar mode, e.g., for grasping, treating, and/or dissectingtissue, and a monopolar mode, e.g., for treating and/or dissectingtissue, is shown generally identified by reference numeral 10. Althoughshown as an endoscopic forceps 10, it is contemplated that forceps 10also be configured for use in connection with traditional open surgicalprocedures. Obviously, different electrical and mechanical connectionsand considerations apply to each particular configuration; however, thenovel aspects with respect to forceps 10 and its operatingcharacteristics remain generally consistent with respect to both theopen and endoscopic configurations.

Continuing with reference to FIGS. 1-3, forceps 10 defines alongitudinal axis “X-X” and includes a housing 20, a handle assembly 30,a slide assembly 60, a rotating assembly 70, a trigger assembly 80, anend effector assembly 100, and a monopolar assembly 200. Forceps 10further includes a shaft 12 having a distal end 14 configured tomechanically engage end effector assembly 100 and a proximal end 16 thatmechanically engages housing 20. Forceps 10 also includeselectrosurgical cable 2 that connects forceps 10 to a generator (notshown) or other suitable power source, although forceps 10 mayalternatively be configured as a battery powered instrument. Cable 2includes wires 2 a extending therethrough that have sufficient length toextend through shaft 12 in order to provide electrical energy to atleast one of the tissue sealing plates 112, 122 of jaw members 110, 120,respectively, of end effector assembly 100, e.g., upon activation offirst activation switch 90. Wires 2 b of cable 2, on the other hand,extend through housing 20 in order to provide electrical energy tomonopolar assembly 200, e.g., upon activation of second activationswitch 95, as will be described in greater detail hereinbelow.

With continued reference to FIGS. 1-3, handle assembly 30 includes fixedhandle 50 and a movable handle 40. Fixed handle 50 is integrallyassociated with housing 20 and movable handle 40 is moveable relative tofixed handle 50. Rotating assembly 70 is rotatable in either directionabout longitudinal axis “X-X” to rotate end effector 100 aboutlongitudinal axis “X-X.” Housing 20 houses the internal workingcomponents of forceps 10.

Referring still to FIGS. 1-3, end effector assembly 100 is shownattached at a distal end 14 of shaft 12 and includes a pair of opposingjaw members 110 and 120. Each of the jaw members 110 and 120 includes anelectrically-insulative outer jaw housing 111, 121 and anelectrically-conductive tissue sealing surface defined by anelectrically-conductive plate 112, 122 disposed atop respective jawhousings 111, 121, although other configurations are contemplated, e.g.,jaw members 110, 120 may be completely formed from anelectrically-conductive material. Tissue sealing plates 112, 122 of jawmembers 110, 120, respectively, are adapted to connect to a source ofenergy (not explicitly shown), e.g., via wires 2 a, for conductingenergy therebetween and through tissue grasped between jaw members 110,120 to treat, e.g., seal, tissue. More specifically, end effectorassembly 100 defines a bipolar configuration wherein tissue sealingplate 112 is charged to a first electrical potential and tissue sealingplate 122 is charged to a second, different electrical potential suchthat an electrical potential gradient is created for conducting energybetween tissue sealing plates 112, 122 and through tissue graspedtherebetween for treating e.g., sealing, tissue. First activation switch90 is coupled to wires 2 a, thus allowing the user to selectively applyenergy to sealing plates 112, 122 of end effector assembly 100.

End effector assembly 100 is designed as a unilateral assembly, i.e.,where jaw member 120 is fixed relative to shaft 12 and jaw member 110 ismovable relative to shaft 12 and fixed jaw member 120. However, endeffector assembly 100 may alternatively be configured as a bilateralassembly, i.e., where both jaw member 110 and jaw member 120 are movablerelative to one another and to shaft 12. In some embodiments, a knifeassembly 180 is disposed within shaft 12 and a knife channel 115, 125 isdefined within one or both jaw members 110, 120 to permit reciprocationof a knife 184 therethrough, e.g., via actuation of a trigger 82 oftrigger assembly 80.

Continuing with reference to FIGS. 1-3, movable handle 40 of handleassembly 30 is ultimately connected to a drive assembly 150 that,together, mechanically cooperate to impart movement of jaw members 110and 120 between a spaced-apart position (FIG. 4A) and an approximatedposition (FIG. 4B) to grasp tissue between tissue sealing plates 112 and122 of jaw members 110, 120, respectively. More specifically, the driveassembly 150 includes a drive sleeve 155 (FIG. 3) that is operablycoupled to jaw member 110 (and/or jaw member 120) such thatlongitudinally translation of drive sleeve 155 through shaft 12 andrelative to end effector assembly 100 pivots jaw member 110 relative tojaw member 120 between the spaced-apart and approximated positions forgrasping tissue therebetween. As shown in FIG. 1, movable handle 40 isinitially spaced-apart from fixed handle 50 and, correspondingly, jawmembers 110, 120 are disposed in the spaced-apart position. Movablehandle 40 is movable from this initial position to a depressed positionfor translating drive sleeve 155 proximally through shaft 12 andrelative to end effector assembly 100 to move jaw members 110, 120 tothe approximated position for grasping tissue therebetween (see FIG.4B). Upon release (or return) of movable handle 40, drive sleeve 155 istranslated distally under the bias of biasing member 158 to return jawmembers 110, 120 to the spaced-apart position.

Referring now to FIGS. 1-4D, monopolar assembly 200 of forceps 10 isshown generally including an electrically-insulative outer tubularmember 210 and an electrically-conductive inner tubular member 220 thatfunctions as the active electrode of monopolar assembly 200. Outertubular member 210 is disposed about and fixedly engaged to innertubular member 220 such that outer tubular member 210 and inner tubularmember 220 move in concert with one another, although outer and innertubular members 210, 220, respectively, may alternatively be movablerelative to one another. Further, a second electrically-insulativemember (not explicitly shown), similar to outer tubular member 210, maybe positioned within electrically-conductive inner tubular member 220such that electrically-conductive inner tubular member 220 is sandwichedbetween a pair of insulating tubular members, although otherconfigurations are also contemplated.

Monopolar assembly 200 is disposed about shaft 12 with proximal ends211, 221 of outer and inner tubular members 210, 220, respectively,extending into housing 20. Proximal end 211 of outer tubular member 210(and/or proximal end 221 of inner tubular member 220), which extendsinto housing 20, is coupled within housing 20 to a slide assembly 60.Slide assembly 60 includes a slide knob 64 that extends from a slot 22defined within housing 20 and is selectively translatable along slot 22to translate monopolar assembly 200 relative to shaft 12 and endeffector assembly 100 between a retracted position (FIGS. 4A-4C) and anextended position (FIG. 4D), as will be described in greater detailbelow. Alternatively, shaft 12 may be coupled to slide assembly 60 andmonopolar assembly 200 may be fixedly engaged to housing 20 such that,upon translation of slide knob 64 of slide assembly 60 along slot 22,shaft 12 and end effector assembly 100 are translated relative tomonopolar assembly 200 between the retracted position (FIGS. 4A-4C) andthe extended position (FIG. 4D). Wires 2 b of cable 2 are coupled toproximal end 221 of inner tubular member 220 to provide energy to innertubular member 220. Second activation switch 95, disposed on housing 20,is coupled to wires 2 b to allow the user to selectively control theapplication of energy to inner tubular member 220.

Inner tubular member 220 includes a body portion 222 and a distal tip224. At least a portion of a distal tip 224 of inner tubular member 220extends distally beyond distal end 213 of outer tubular member 210 ofmonopolar assembly 200 such that electrically-conductive distal tip 224is at least partially exposed. Thus, in the extended position (FIG. 4D),as will be described in greater detail below, the exposed portion ofelectrically-conductive distal tip 224 of inner tubular member 220extends distally beyond end effector assembly 100 to facilitatetreating, e.g., mechanically, electrically, or electromechanicallydissecting, tissue. For treating tissue with monopolar assembly 200,energy is applied from wires 2 b, e.g., upon activation of secondactivation switch 95, and is conducted along inner tubular member 220 todistal tip 224 thereof for application to tissue. A return pad (notshown) is remotely placed to receive energy conducted from the monopolarelectrode, e.g., inner tubular member 220 and, more specifically, distaltip 224 thereof, through tissue. Distal tip 224, as will be described ingreater detail below, may be releasably engagable with body 222 of innertubular member 220 such that monopolar assembly 200 may assume variousdifferent configurations, depending on a particular purpose.

Monopolar assembly 200 may be biased towards the retracted positionand/or may include a locking assembly (not shown) for selectivelylocking monopolar assembly 200 in the retracted and/or the extendedposition. Further, internal circuitry (not explicitly shown) coupled tofirst and second activation switches 90, 95, respectively, and wires 2a, 2 b may be provided for inhibiting energization of tissue sealingplates 112, 122 when monopolar assembly 200 is disposed in the extendedposition and/or for inhibiting energization of distal tip 224 of innertubular member 220 when monopolar assembly 200 is disposed in theretracted position. Alternatively or additionally, mechanical mechanisms(not explicitly shown) for inhibiting activation of activation switches90, 95 may also be provided for similar purposes. For example, theproximal end of monopolar assembly 200 may be configured to interferewith activation switch 95 when in the retracted position, therebyinhibiting activation of activation switch 95 when monopolar assembly200 is disposed in the retracted position. Such features may similarlyapply to any of the other embodiments described herein.

Turning now to FIGS. 4A-4D, in conjunction with FIG. 1, the use andoperation of forceps 10 in both the bipolar mode, e.g., for grasping,treating and/or cutting tissue, and the monopolar mode, e.g., forelectrical/electromechanical tissue treatment, is described. Initially,with respect to the bipolar mode, as shown in FIG. 4A, jaw members 110,120 are disposed in the spaced-apart position. In the bipolar mode,monopolar assembly 200 remains disposed in the retracted position, asshown in FIGS. 4A-4C, wherein distal tip 224 of inner tubular member 220is positioned proximally of jaw members 110, 120. With jaw members 110,120 disposed in the spaced-apart position, end effector assembly 100 maybe maneuvered into position such that tissue to be grasped, treated,e.g., sealed, and/or cut, is disposed between jaw members 110, 120.Next, movable handle 40 is depressed, or pulled proximally relative tofixed handle 50 such that jaw member 110 is pivoted relative to jawmember 120 from the spaced-apart position to the approximated positionto grasp tissue therebetween, as shown in FIG. 4B. More specifically,upon actuation of movable handle 40, drive sleeve 155 (FIG. 3) istranslated proximally through shaft 12, pulling jaw member 110 to pivotrelative to jaw member 120 from the spaced-apart position to theapproximated position. In this approximated position, energy may besupplied, e.g., via activation of switch 90, to tissue-sealing plate 112of jaw member 110 and/or tissue-sealing plate 122 of jaw member 120 andconducted through tissue to treat tissue, e.g., to effect a tissue sealor otherwise treat tissue.

The disposition of monopolar assembly 200 in the retracted position,e.g., where distal tip 224 of inner tubular member 220 isproximally-spaced from end effector assembly 100, as well as thepositioning of insulative outer tubular member 210 about inner tubularmember 220, helps inhibit capacitive coupling between tissue sealingplates 112, 122 and distal tip 224 of monopolar assembly 200, e.g.,helps inhibit distal tip 224 from being heated or energized, as energyis supplied to tissue sealing plate 112 and/or tissue sealing plate 122for tissue sealing (or otherwise treating tissue). Maintaining distaltip 224 in an un-energized state while not in use helps protect tissuesurrounding forceps 10.

As shown in FIG. 4C, in conjunction with FIG. 1, once tissue treatmentis complete (or to cut untreated tissue), knife 184 of knife assembly180 may be deployed from within shaft 12 to between jaw members 110,120, e.g., via actuation of trigger 82 of trigger assembly 80, to cuttissue grasped therebetween. More specifically, upon actuation oftrigger 82, knife 184 is advanced distally from shaft 12 to extend atleast partially through knife channels 115, 125 of jaw members 110, 120,respectively, to cut tissue grasped between jaw members 110, 120.Thereafter, knife 184 may be returned to within shaft 12 and jaw members110, 120 may be moved back to the spaced-apart position (FIG. 4A) torelease the treated and/or divided tissue.

With reference to FIGS. 4B and 4D, in conjunction with FIG. 1, withrespect to the monopolar mode, movable handle 40 is first depressedrelative to fixed handle 50 to pivot jaw member 110 relative to jawmember 120 from the spaced-apart position to the approximated position.With jaw members 110, 120 disposed in the approximated position,monopolar assembly 200 may be translated from the retracted position(FIG. 4B) to the extended position (FIG. 4D). More specifically, inorder to translate monopolar assembly 200 from the retracted position(FIG. 4B) to the extended position (FIG. 4D), slide knob 64 of slideassembly 60 is translated distally along slot 22 defined within housing20 from proximal end 23 of slot 22 to distal end 25 thereof such thatouter and inner tubular members 210, 220, respectively, are translateddistally over shaft 12 and, ultimately, over jaw members 110, 120,respectively, until distal tip 224 of inner tubular member 220 extendsdistally from end effector assembly 100. In the extended position, outertubular member 210 of monopolar assembly 200 is completely disposed overjaw members 110, 120, and a portion thereof may extend distally beyondjaw members 110, 120. In embodiments where outer and inner tubularmembers 210, 220 are independently movable relative to one another,multiple slide knobs 64 may be provided for moving each of outer andinner tubular members 210, 220 between the retracted and extendedpositions independently of one another. Other deployment mechanisms arealso contemplated.

With monopolar assembly 200 disposed in the extended position, as shownin FIG. 4D, second activation switch 95 may be actuated to supply energyto inner tubular member 220 such that energy is conducted along innertubular member 220 to distal tip 224 thereof, and from distal tip 224 totissue to treat, e.g., dissect, tissue. As mentioned above, energy isreturned via a remotely positioned return pad (not explicitly shown).During application of energy to distal tip 224, forceps 10 may be movedrelative to tissue, e.g., longitudinally along longitudinal axis “X-X”and/or radially therefrom, to facilitate electromechanical treatment oftissue. Alternatively or additionally, forceps 10 may be moved relativeto tissue to facilitate mechanically dissecting tissue, e.g., scoringtissue planes, with distal tip 224 in the absence of energy beingapplied to distal tip 224.

During application of energy to distal tip 224, outer tubular member 210electrically insulates body portion 222 of inner tubular member 220 fromsurrounding tissue to help protect the surrounding tissue. Further, withjaw members 110, 120 disposed in the approximated position, insulativejaw housings 111, 121 insulate the respective tissue sealing plates 112,122 from inner tubular member 220 to help inhibit capacitive couplingtherebetween. As mentioned above, a second electrically-insulativemember (not explicitly shown) may be positioned withinelectrically-conductive inner tubular member 220 to facilitate theisolation of tissue sealing plates 112, 122 from distal tip 224 whenmonopolar assembly 220 is disposed in the retracted position. In eitherconfiguration, damage to surrounding tissue as a result of capacitivecoupling is inhibited.

At the completion of tissue treatment, e.g., dissection, monopolarassembly 200 may be returned to the retracted position (FIGS. 4A-4B),e.g., via translating slide knob 64 of slide assembly 60 proximallyalong slot 22 to proximal end 23 thereof. With monopolar assembly 200once again in the retracted position, jaw members 110, 120 of endeffector assembly 100 may be manipulated to grasp, treat, and/or cuttissue, as described above, in the bipolar mode.

Turning now to FIGS. 5 and 5A-5D, monopolar assembly 200 is shownincluding a plurality of distal tips 224 a, 224 b, 224 c, 224 dconfigured for use therewith. As mentioned above, distal tips 224 a, 224b, 224 c, 224 d may be releasably engagable with body 222 of innertubular member 220 of monopolar assembly 200. More specifically, body222 of inner tubular member 220 includes an engagement feature, e.g.,threading 226, defined at distal end 223 thereof, while distal tips 224a, 224 b, 224 c, 224 d each include a complementary engagement feature,e.g., complementary threading 228, at the proximal end thereof forreleasable engagement with threading 226 of body 222 of inner tubularmember 220. Other releasably engagement features are also contemplated,e.g., friction-fitting, latching, etc.

With continued reference to FIGS. 5 and 5A-5D, various differentconfigurations of distal tips 224 a, 224 b, 224 c and 224 d are shown.Distal tip 224 a is shown including a beveled distal end 225 a; distaltip 224 b is shown including a generally linear blade 225 b extendingdistally therefrom; distal tip 224 c is shown including a hook 225 cextending distally therefrom; and distal tip 224 d is shown defining agenerally annular distal end 225 d. Other configurations may also beprovided. A desired configuration of distal tip may be selected andengaged to body 222 of inner tubular member 220 depending on theparticular purpose. For example, where it is desired to treat tissue viadistal advancement of forceps 10 (FIG. 1), distal tip 224 a, distal tip224 b, or distal tip 224 d may be selected (depending on the size and/orcomposition of tissue to be dissected). On the other hand, where it isdesired to treat tissue via proximal movement of forceps 10 (FIG. 1),distal tip 224 c may be selected.

Various other embodiments of end effector assemblies and/or monopolarassemblies provided in accordance with the present disclosure andconfigured for use with forceps 10 (FIG. 1) or any other suitablesurgical instrument are described below with reference to FIGS. 6A-10.These end effector assemblies and/or monopolar assemblies are similar toend effector assembly 100 and monopolar assembly 200 (see FIGS. 1-3),respectively, described above. Accordingly, for purposes of brevity,only the differences will be described hereinbelow, keeping in mind thatany or all of the features of end effector assembly 100 (FIG. 2),monopolar assembly 200 (FIG. 3), and/or forceps 10 (FIG. 1), to theextent consistent, may similarly apply to the end effector assemblies,monopolar assemblies, and instruments associated therewith,respectively, described below.

Turning now to FIGS. 6A-6B, another embodiment of a monopolar assemblyprovided in accordance with the present disclosure is shown generallyidentified by reference numeral 300. Monopolar assembly 300 isconfigured for use with end effector assembly 100 and a forceps similarto forceps 10 (FIG. 1), except that shaft 12′ of the forceps furtherincludes an insulative member, e.g., distal sleeve 18′, mounted thereontowards distal end 14′ thereof that is configured to receiveelectrically-conductive monopolar rod member 320 therein when monopolarassembly 300 is disposed in the retracted position, as will be describedbelow. Further, monopolar assembly 300 is similar to monopolar assembly200 (FIG. 3), except that, rather than including anelectrically-conductive inner tubular member 220 (FIG. 3), monopolarassembly 300 includes a monopolar rod member 320 having an exposedelectrically-conductive portion, e.g., distal tip 324.

With continued reference to FIGS. 6A-6B, monopolar assembly 300 includesan electrically-insulative outer tubular member 310 that is disposedabout shaft 12′ and a monopolar rod member 320 that extends throughouter tubular member 310 (adjacent shaft 12′) and distally therefrom,ultimately defining an exposed electrically-conductive hook-shapeddistal tip 324 (although other configurations may also be provided). Rodmember 320 and, more specifically, distal tip 324 thereof, functions asthe active electrode of monopolar assembly 300. Outer tubular member 310may be fixedly engaged to rod member 320 such that outer tubular member310 and rod member 320 move in concert with one another between theretracted position (FIG. 6A) and the extended position (FIG. 6B), e.g.,upon translation of slide knob 64 (FIG. 1). Alternatively, outer tubularmember 310 and rod member 320 may be coupled to one another to effectsimultaneous but differential deployment of outer tubular member 310 androd member 320 relative to one another, or may be independent of oneanother such that outer tubular member 310 and/or rod member 320 may beselectively deployed independently of one another.

In the retracted position, as shown in FIG. 6A, distal tip 324 ofmonopolar assembly 300 is disposed within an insulating member, e.g.,distal sleeve 18′ of shaft 12′, disposed towards distal end 14′ of shaft12′. Distal sleeve 18′ is electrically-insulated such that distal tip324 of rod member 320 is isolated from tissue sealing plates 112, 122 ofjaw members 110, 120, respectively, and from surrounding tissue whendisposed in the retracted position, thereby inhibiting capacitivecoupling and resulting damage to surrounding tissue.

In the extended position, as shown in FIG. 6B, outer tubular member 310is disposed about jaw members 110, 120 of end effector assembly 100,while distal tip 324 of rod member 320 extends distally therefrom. Inthis position, energy may be applied to distal tip 324 of rod member 320to treat tissue. A return pad (not shown) positioned at a remotelocation is used to return energy transmitted from distal tip 324 of rodmember 320 through tissue. Further, in the extended position, monopolarassembly 300 and, more particularly, rod member 320 thereof, may berotated relative to end effector assembly 100, e.g., via rotating asecond rotating assembly (similar to rotating assembly 70 (FIG. 1))disposed within housing 20 (FIG. 1) and coupled to monopolar assembly300, to better position distal tip 324 of rod member 320 relative totissue.

Turning to FIG. 6C, another embodiment of a monopolar assembly 400similar to monopolar assembly 300 is shown. Monopolar assembly 400differs from monopolar assembly 300 in that insulative outer tubularmember 410 of monopolar assembly 400 forms the shaft of the forceps (oris fixedly disposed about the shaft of the forceps) and is fixed inposition relative to end effector assembly 100. Monopolar rod member 420extends through and distally from outer tubular member 410 and ismovable relative to end effector assembly 100 and insulative outertubular member 410 between the retracted position and the extendedposition. Rod member 420 may include an insulative sleeve or coating 426disposed about body portion 422 thereof, such that distal hook 424 isthe only exposed electrically-conductive portion of rod member 420.Distal hook 424 of rod member 420 is received within a recess definedwithin a distal sleeve 418 that extends from distal end 414 of outertubular member 410 when in the retracted position, thereby helping toprotect surrounding tissue.

Referring to FIG. 6D, another embodiment of an end effector assembly100′ incorporating a monopolar assembly 400′ is shown. End effectorassembly 100′ is similar to end effector assembly 100 (FIGS. 1-4D),while monopolar assembly 400′ is similar to monopolar assembly 300(FIGS. 6A-6B) and monopolar assembly 400 (FIG. 6C). Accordingly, onlythe differences between end effector assembly 100′ and monopolarassembly 400′ as compared to the previous embodiments describedhereinabove will be described in detail below.

Continuing with reference to FIG. 6D, each jaw member 110′, 120′ of endeffector assembly 100′ includes a distal jaw portion 111′, 121′including a tissue sealing surface defined by an electrically-conductivetissue-sealing plate 112′, 122′, and a proximal flange 114′, 124′extending proximally from the respective distal jaw portion 111′, 121′.Proximal flanges 114′, 124′ are configured to receive pivot pin 95′ topivotably couple jaw members 110′, 120′ to one another and may be formedat least partially from, or coated at least partially with an insulativematerial. The proximal flange of one of the jaw members, e.g., proximalflange 124′ of jaw member 120′, further defines a lumen 126′ extendingtherethrough and a recess 128′ defined within the distal surface ofproximal flange 124′ that communicates with lumen 126′. Thisconfiguration of proximal flange 124′ of jaw member 120′ permits body422′ of rod member 420′ of monopolar assembly 400′ to extend throughproximal flange 124′ of jaw member 120′, e.g., through lumen 126′, whilealso permitting distal hook 424′ of rod member 420′ of monopolarassembly 400′ to be received within recess 128′ of proximal flange 124′when monopolar assembly 400′ is disposed in the retracted position,thereby helping to protect surrounding tissue. In other words, ratherthan providing an insulative sleeve for retaining monopolar assembly400′ when monopolar assembly 400′ is disposed in the retracted position,jaw member 120′ itself is configured to retain monopolar assembly 400′therein when monopolar assembly 400′ is disposed in the retractedposition.

Turning now to FIGS. 6E-6F, another embodiment of an end effectorassembly 100″ incorporating a monopolar assembly 400″ is shown. Endeffector assembly 100″ is similar to end effector assembly 100′ (FIG.6D), while monopolar assembly 400″ is similar to monopolar assembly 400′(FIG. 6D), although end effector assembly 100″ and/or monopolar assembly400″ may alternatively be configured similarly to any of the other endeffector assemblies and monopolar assemblies described herein. Forpurposes of brevity, only the differences between end effector assembly100″ and monopolar assembly 400″ as compared to end effector assembly100′ (FIG. 6D) and monopolar assembly 400′ (FIG. 6D), respectively, willbe described in detail below.

With continued reference to FIGS. 6E-6F, each jaw member 110″, 120″ ofend effector assembly 100″ includes a distal jaw portion 111″, 121″having a tissue-sealing plate 112″, 122″ disposed thereon, and aproximal flange 114″, 124″ extending proximally from the respectivedistal jaw portion 111″, 121″. The proximal flange of one of the jawmembers, e.g., proximal flange 124″ of jaw member 120″, further definesa lumen 126″ and a recess 128″ configured to receive body 422″ of rodmember 420″ of monopolar assembly 400″ and distal hook 424″ of rodmember 420″ of monopolar assembly 400″, respectively, when monopolarassembly 400″ is disposed in the retracted position (FIG. 6F). Further,jaw members 110″ and 120″ of end effector assembly 100″ define curvedconfigurations, e.g., to facilitate manipulation of tissue and toprovide better “line of sight” for accessing targeted tissues, althoughother configurations may also be provided. More specifically, jawmembers 110″, 120″ are curved towards the side of end effector assembly100″ wherein monopolar assembly 400″ is disposed, such that the overallwidth dimension of end effector assembly 100″ is not increased by thepresence of monopolar assembly 400″.

One of the jaw members, e.g., jaw member 120″, includes a channel-shapedcut-out 129″ defined within distal jaw portion 121″ towards the distalend thereof. Cut-out 129″ is configured to permit reciprocation ofmonopolar assembly 400″ between the retracted position, whereinmonopolar assembly 400″ is disposed within proximal flange 124″ of jawmember 120″, and the extended position, wherein distal hook 424″ ofmonopolar assembly 400″ extends distally from end effector assembly100″. More specifically, due to the curved configurations of jaw members110″, 120″, the distal end of jaw member 120″ curves into the path ofmonopolar assembly 400″. Cut-out 129″ defines a channel through whichmonopolar assembly 400″ is configured to extend, thus permittingextension of distal hook 424″ distally beyond end effector assembly 100″without interference by jaw member 120″ and guiding theextension/retraction of monopolar assembly 400″.

With reference to FIGS. 7A-7B, a jaw member 520 of an end effectorassembly 500 that incorporates a monopolar rod member 530 therein isshown. Jaw member 520, similar to jaw members 110, 120 of end effectorassembly 100 (see FIGS. 1-3), includes an insulative outer jaw housing521 and an electrically-conductive tissue sealing plate 522 disposedatop jaw housing 521. However, jaw housing 521 further includes a lumen(not explicitly shown) extending therethrough that is configured toslidably receive body 532 of rod member 530 and a complementary-shapedrecess 528 defined therein that communicates with the lumen (notexplicitly shown). Recess 528 is defined within distal end 523 of jawmember 520 and is configured to receive distal tip 534 of rod member 530therein when rod member 530 is disposed in the retracted position. Morespecifically, in the retracted position, rod member 530 is fullydisposed within recess 528 of jaw housing 521 of jaw member 520 suchthat rod member 530 is electrically insulated from tissue sealing plate522 (and the tissue sealing plate of the other jaw member (not shown) ofend effector assembly 500). In the extended position, rod member 530extends distally from recess 528 and jaw member 520 to facilitatemonopolar tissue treatment. As in the previous embodiments, aninsulative tubular member (not explicitly shown) may be provided toslide distally over and further electrically insulate end effectorassembly 500 from rod member 530 as rod member 530 is moved to theextended position. Rod member 530 may also be rotatable relative to endeffector assembly 500.

Referring to FIGS. 8A-8B, another embodiment of an end effector assembly600 similar to end effector assembly 500 (FIGS. 7A-7B) is shownincluding a monopolar wire member 630 within one of the jaw members 610,620, e.g., jaw member 620. More specifically, jaw member 620 includes alumen 626 extending longitudinally through insulative jaw housing 621thereof and an electrically-conductive monopolar wire member 630slidably received within lumen 626. At least a portion of wire member630 is formed from a resilient material, or is otherwise configured suchthat distal tip 634 of wire member 630 is capable of assuming asubstantially linear configuration relative to body 632 of wire member630, thus permitting wire member 630 to be completely retracted withinlumen 626 in a substantially linear configuration. Upon extension ofwire member 630 from lumen 626, e.g., upon movement of wire member 630to the extended position, distal tip 634 of wire member 630 assumes acurved, hook-shaped, or other suitable configuration to facilitatetissue dissection. Wire member 630 may also be rotatable relative to jawmember 620 when in the extended position, similarly as described abovewith respect to rod member 330 (FIGS. 6A-6B). Further, an outerinsulative sleeve (not shown) may also be provided to surround endeffector assembly 600 upon extension of monopolar member 630, similarlyas described above with respect to the previous embodiments.

Turning now to FIGS. 9A-9B, another embodiment of an end effectorassembly provided in accordance with the present disclosure is showngenerally indentified by reference numeral 700. End effector assembly700 includes first and second electrically-conductive jaw members 710,720 (although a portion of jaw members 710, 720 may be covered with orcoated by an insulative material) that are movable relative to oneanother between a spaced-apart position and an approximated position forgrasping tissue therebetween. Each jaw member 710, 720 includes agenerally linear body portion 712, 722 defining a tissue sealing surface713, 723, respectively. One or both of the jaw members 710, 720 furtherincludes a hook-shaped, or curved distal portion 714, 724, respectively,extending from respective body portion 712, 722 thereof. Jaw members710, 720 are adapted to connect to a source of energy (not explicitlyshown) for supplying energy thereto in each of a bipolar mode and amonopolar mode. More specifically, in the bipolar mode, jaw member 710is charged to a first electrical potential and jaw member 720 is chargedto a second, different electrical potential such that an electricalpotential gradient is created for conducting energy therebetween andthrough tissue grasped therebetween for treating e.g., sealing, tissue.

In the monopolar mode, on the other hand, jaw members 710, 720 areapproximated and energized to the same electrical potential such thatenergy is conducted from jaw members 710, 720 and, more particularly,distal portions 714, 724, respectively, thereof, through tissue to aremotely located return pad (not explicitly shown) for treating, e.g.,dissecting, tissue. The particular configuration of jaw members 710,720, e.g., wherein either or both jaw members 710, 720 include hookeddistal portions 714, 724, respectively, facilitates monopolar dissectionof tissue in that, when jaw members 710, 720 are disposed in theapproximated position, hooked distal portion 714 and/or hooked distalportion 724 (either alone or in cooperation with one another) define amonopolar, active electrode probe 730. That is, rather than providing aseparate monopolar element, distal portions 714, 724 of jaw members 710,720, respectively, function as the monopolar element when operating inthe monopolar mode.

Turning to FIG. 9C, end effector assembly 700, in some embodiments, mayfurther include an insulative tubular member 740 disposed about bodyportions 712, 722 of jaw members 710, 720, respectively. Insulativetubular member 740 includes a distal cut-out 742 such that monopolarprobe 730, e.g., hooked distal portions 714, 724 of jaw member 710, 720,is exposed when insulative tubular member 740 is extended about endeffector 700 to facilitate monopolar tissue treatment. Thisconfiguration also protects surrounding tissue by electrically isolatingbody portions 712, 722 of jaw members 710, 720, respectively, fromsurrounding tissue during operation in the monopolar mode. Insulativetubular member 740 may be extended and retracted similarly as describedabove with respect to any of the previous embodiments.

With reference to FIG. 10, another embodiment of an end effectorassembly provided in accordance with the present disclosure andconfigured for operation in both a bipolar mode and a monopolar mode isshown generally indentified by reference numeral 800. End effectorassembly 800 is similar to end effector assembly 700 (FIGS. 9A-9C),except that, rather than including generally linear body portions andhook-shaped distal portions, jaw members 810, 820 define complementarycurved configurations substantially along the lengths thereof. Thecurved configurations of jaw members 810, 820 facilitate spreadingand/or separating tissue to provide access to underlying tissue forgrasping, treating, e.g., sealing, and/or dividing the underlying tissue(in the bipolar mode). Further, similar to end effector assembly 700(FIGS. 9A-9C), a monopolar, active electrode probe 830 is formed via thecooperation of distal ends 814, 824 of jaw members 810, 820,respectively, when jaw members 810, 820 are disposed in the approximatedposition, thereby facilitating monopolar tissue treatment (in themonopolar mode). Any of the other features of end effector assembly 700(FIGS. 9A-9C), described above and to the extent consistent, applysimilarly to end effector assembly 800 and, thus, are not repeated here.

From the foregoing and with reference to the various figure drawings,those skilled in the art will appreciate that certain modifications canalso be made to the present disclosure without departing from the scopeof the same. While several embodiments of the disclosure have been shownin the drawings, it is not intended that the disclosure be limitedthereto, as it is intended that the disclosure be as broad in scope asthe art will allow and that the specification be read likewise.Therefore, the above description should not be construed as limiting,but merely as exemplifications of particular embodiments. Those skilledin the art will envision other modifications within the scope and spiritof the claims appended hereto.

What is claimed is:
 1. A surgical instrument, comprising: a housing; ashaft extending distally from the housing; an end effector assemblyextending distally from the shaft, the end effector assembly includingfirst and second jaw members, at least one of the first or second jawmembers movable relative to the other between a spaced-apart positionand an approximated position for grasping tissue therebetween, at leastone of the first or second jaw members including a distal tip; and aninsulative tubular member disposed about the shaft and movable relativeto the end effector assembly between a retracted position and anextended position wherein the insulative tubular member is disposedabout the end effector assembly and the distal tip of the at least oneof the first or second jaw members remains exposed, wherein, in theretracted position of the insulative tubular member, the first andsecond jaw members are configured to conduct bipolar energy to tissuegrasped therebetween to treat tissue, and wherein, in the extendedposition of the insulative tubular member, the distal tip of the atleast one of the first or second jaw members is configured to conductmonopolar energy to tissue to treat tissue.
 2. The surgical instrumentaccording to claim 1, wherein the insulative tubular member defines acut-out, and wherein, in the extended position of the insulative tubularmember, the distal tip of the at least one of the first or second jawmembers is exposed through the cut-out.
 3. The surgical instrumentaccording to claim 2, wherein, in the extended position of theinsulative tubular member, the distal tip of the at least one of thefirst or second jaw members extends at least partially through thecut-out.
 4. The surgical instrument according to claim 1, wherein thedistal tip of the at least one of the first or second jaw membersdefines a hooked configuration.
 5. The surgical instrument according toclaim 1, wherein, in the extended position of the insulative tubularmember, the distal tip of each of the first and second jaw membersremains exposed and is configured to conduct monopolar energy to tissueto treat tissue.
 6. The surgical instrument according to claim 1,further comprising an actuator disposed on the housing and operablycoupled to the insulative tubular member, the actuator selectivelyactuatable from an un-actuated position to an actuated position to movethe insulative tubular member from the retracted position to theextended position.
 7. The surgical instrument according to claim 1,further comprising a movable handle operably coupled to the housing andat least one of the first or second jaw members, the movable handleselectively movable from an initial position to a depressed position tomove the at least one of the first or second jaw members relative to theother from the spaced-apart position to the approximated position. 8.The surgical instrument according to claim 1, wherein, the first andsecond jaw members are energized to different potentials to enable thefirst and second jaw members to conduct bipolar energy to tissue graspedtherebetween to treat tissue, and wherein the first and second jawmembers are energized to the same potential to enable the distal tip ofthe at least one of the first or second jaw members to conduct monopolarenergy to tissue to treat tissue.
 9. The surgical instrument accordingto claim 1, further comprising a first activation button disposed on thehousing and electrically coupled to the first and second jaw members,the first activation button selectively activatable to initiate thesupply of bipolar energy to the first and second jaw members.
 10. Thesurgical instrument according to claim 1, further comprising a secondactivation button disposed on the housing and electrically coupled tothe at least one of the first or second jaw members, the secondactivation button selectively activatable to initiate the supply ofmonopolar energy to the at least one of the first or second jaw members.11. The surgical instrument according to claim 1, wherein the first andsecond jaw members each include an opposed electrically-conductivesurface, the opposed electrically-conductive surfaces configured toconfigured to conduct bipolar energy to tissue grasped therebetween totreat tissue.
 12. The surgical instrument according to claim 11, whereinthe distal tip of the at least one of the first or second jaw members iselectrically-conductive and electrically coupled to the opposedelectrically-conductive surface of the corresponding jaw member.
 13. Thesurgical instrument according to claim 1, wherein at least a portion ofeach of the first and second jaw members is insulative.
 14. A method ofsurgery, comprising: selecting whether to treat tissue with bipolarenergy or monopolar energy; if treating tissue with bipolar energy isselected: grasping tissue between first and second jaw members; and withtissue grasped between the first and second jaw members, conductingbipolar energy between the first and second jaw members to treat thegrasped tissue; if treating tissue with monopolar energy is selected:extending an insulative tubular member about the first and second jawmembers such that only a distal tip of at least one of the first orsecond jaw members is exposed; and with the insulative tubular memberextended, conducting monopolar energy from the distal tip of the atleast one of the first or second jaw members to treat adjacent tissue.15. The method according to claim 14, wherein conducting bipolar energyincludes energizing the first and second jaw members to differentpotentials.
 16. The method according to claim 14, wherein conductingmonopolar energy includes energizing the first and second jaw members tothe same potential.
 17. The method according to claim 14, whereinconducting bipolar energy between the first and second jaw members totreat the grasped tissue includes sealing the grasped tissue.
 18. Themethod according to claim 14, wherein conducting monopolar energy fromthe distal tip of the at least one of the first or second jaw members totreat the adjacent tissue includes dissecting the adjacent tissue. 19.The method according to claim 14, wherein, with the insulative tubularmember extended, the distal tip of the at least one of the first orsecond jaw members is exposed through a cut-out defined within theinsulative tubular member.
 20. The method according to claim 14, whereinthe distal tip of the at least one of the first or second jaw members isconfigured to extend at least partially through the cut-out when theinsulative tubular member is extended.